Cosmetic

Introduction to the case

I had a patient yesterday that came in for recall, CC that her flipper was broken. She has congenitally missing laterals #7/10 and originally came to my office for repair of an older flipper, which we did, and after it broke again we made her a new one. That one lasted about 2 year before it also broke.

She had planned on just having the flipper repaired again, but after discussing her options, she was sick of wearing it and always having it break, so we elected to do a bonded bridge.

This is my first direct attempt at this, but I’d seen a few case reports on the technique, along with all the great posts on here, so I had a pretty good idea of how I wanted to approach this.

I apologize for the poor photos, I’m using a 10 year old point and shoot camera and since this was unplanned we didn’t have a lot of time for perfect shots. I’d love some feedback on shade, contour, etc., as compared to what I see by some of the docs on here this look like chiclets.

Started by taking an alginate and doing a quick wax-up over lunch. Pt approved and we got to work. Began by bonding Fiber-Splint ML by Polydentia for added strength and to act as a framework to build off. I don’t love the stuff and the fiber-glass tends to come apart after you cut it and soak in BA, but it’s all we have. Used a putty mold from the wax-up to establish the incisal edge. Composite used was Filtek SU A3D (dentin) and A2E (enamel). Polished w/ brownie and rubber cup.

Introduction to the case

Patient received 6 porcelain veneers with minimal or conservative teeth preparation. The prep process was conservative to minimize removal of tooth structure. The images show tooth discoloration caused by old composite bondings. Following treatment, the teeth are whiter and less crowded.

Introduction to the case

69 year old gentleman came in for consult on bonding. Recent crown on right canine had broken off and he was balancing it in place. Lots of wear on remaining anterior teeth. He came back 2 weeks later for an elective root canal so I could place a prefab metal post and bond his crown in place. He was back a month later when I bonded his 5 remaining anterior teeth.

Some one placed a case asking for help with lengthening anterior teeth and I discovered these pictures buried in my computer so thought I’d post them to maybe help answer some questions about the problem.

Introduction to the case

This is one of my most MacGyver cases to date. This patient has extensive damage from wear and erosion and was ready to restore his mouth before it gets any worse. He is now a faithful nightguard wearer but nonetheless, those masseters made me really nervous.

I like to test drive big cases in composite before committing to porcelain because if they’re going to be breaking stuff, it sure helps to figure out why and correct it before proceeding to finals. You can certainly do it with just a bisacryl overlay but it tends to pop off and you can’t really leave it on as a buildup. Doing the mockup in a real composite allows you to break the teeth up individually for flossing and allow them to wear it longer. It also serves as a buildup by filling in deficient areas of tooth.

In this case, I generated a template from a waxup and used it to injection mold the intraoral mockup. The contacts were broken by inserting mylar strips interproximally.

I chose to use Activa here for a variety of reasons. It is injectable, it’s dual cure, it doesn’t have to have a bonding agent, and it is very resistant to wear and chipping. The bioactive aspect is icing on the cake making it far less likely to have secondary decay.

Introduction to the case

The dreaded single central. Patient was concerned because her “front tooth had been getting darker over the past three months”. Endodontic therapy had been performed 10 years prior. Sketchy mid-root region, endodontist confirmed resorption. Patient wouldn’t be able to get the exo for a while. This restoration is meant to be a long term provisional, but I saw no better way to address the situation given the circumstances.

Introduction to the case

This 50 year old patient was in today for a check-up on his teeth. I had not seen him for 20 months since we restored his lower teeth. We had restored his upper teeth 2 months previous to doing his lower teeth. He came from another neighboring dental office where they don’t do composite rehabs. He has been into this other office for several cleanings since we did his rehab but he smokes, loves his coffee and has lots of stain. Anyway I was wondering how he was making out with his new teeth and he was very satisfied. In his words “no pain or sensitivity or problems”. So I was quite happy with his rehab. His wife came as well and we knew each other from 30 years ago when my daughters and I were riding horses in the same horse club. There were a few air bubbles that I didn’t like and a small open margin that I repaired and that was all he needed to spiffy him up.

Introduction to the case

43 year old female presented with chief complaint of “I need to fix my smile, I have a wedding to attend in August (in 3 months)”. Patient had generalized moderate chronic perio, decided to not pursue ortho tx. Initially, we decided to exo canine in lateral incisor position, and create a 4 unit FPD 8-9-x-“11”. After FPD and the wedding, we will proceed forward with endo and PCC on #9. However, due to careful preparation, we managed to preserve the teeth, avoid the extraction, and altered the treatment plan to four emax crowns.